Oral habits 2018
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Oral habits in Orthodontics 2018 dental.
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Oral habits 2018
- 1. Habits By Dr Roni R Kuttickal Coorg Institute of dental sciences August 2018
- 2. Contents 1. Habits âš Definition âš Development âš Classification âš Dental response to pressure habits âš Treatment philosophy 2. Suckling Habits 3. Tongue thrusting 4. Mouth breathing 5. Lip habits 6. Bruxism 7. Tongue sucking 8. Frenum thrusting 9. Pillowing habits 10. Nail biting 11. Postural habits 2
- 3. â ⸠A habit is a fixed practice, produced by constant repetition of an act and At each repetition the act becomes less conscious and if repeated often enough may be relegated to the subconscious mind entirely. Thompson 1927 3 By Dr Roni R Kuttickal Coorg Institute of dental sciences
- 4. DEVELOPMENT OF A HABIT ⸠The newborn develops some patterns 1. Instinct : pattern and order- are inherited, 2. Habit: pattern and order- acquired due to repetition
- 5. At the beginning, The infant makes an effort by frequent learning and practice later on the muscles start responding more readily At the onset it takes a long time for the impulses to pass along the efferent nerves to muscle involved which evolves as time passes
- 6. 6 Children acquire habits that are sometimes temporary or permanent In initial phases habits are a conscious effort ,gradually it becomes less conscious and subconscious later as it is repeated Oral habits have a definitive role in development of a child , his oral characteristics Habit
- 7. It has been stated that unconscious mental pattern of childhood develops from five sources namely ďInstinct, ďInsufficient or in correct outlet of energy, ďPain or discomfort, ďAbnormal physical size of parts, ďImitation of or imposition of others
- 8. Habits and Age 8 During the first 3 years Beyond 3.5 years After 4 years of age After the eruption of the permanent incisors Anterior open bite Not confined DETRIMENTAL Damage Maximum damage is seen Strongly established
- 9. Malocclusion produced by the habit ⸠Position of the digit/pacifier etc ⸠Associated orofacial muscle contraction force ⸠Mandibular position during sucking ⸠Amount, frequency, & duration of force applied ⸠Facial skeletal genetic pattern 9
- 10. Classification By Dr Roni R Kuttickal Coorg Institute of dental sciences
- 11. Klein (1952) believed that the habits fall into broad category of: 1. Intentional pressure: 2. Unintentional pressure
- 12. 12 Unintentional pressure was sub classified as 3 catagories 1. Intrinsic pressure ( Within the mouth ) a) Thumb sucking b) Finger sucking c) Tongue thrust swallow d) Mouth breathing e) Tongue, lip, cheek, blanket-sucking f) Nail, lip, tongue biting g) Macroglossia, overgrowth of the tongue h) Incorrect swallowing, anaesthesia throat.
- 13. I. Chin propping II. Face leaning on hand III. Abnormal pillowing positions Unintentional pressure was sub classified as 3 2 ) Extrinsic pressure
- 14. 14 Unintentional pressure was sub classified as 3 ) functional pressure habits- Malocclusions seen in Musicians
- 15. William james classified Useful habits Harmful habits 15 a)correct tongue position, b)proper respiration, c)proper deglutition and d)normal usage of lips in speaking
- 17. It can be classified into 2 main categories 1) Nutritive habits 2) Non Nutritive habits 17
- 18. 18 1) Nutritive habits â it provides nutrients to the child ⢠Breast feeding â˘Bottle feeding
- 19. Breast feeding ⸠A nutritive habit which promotes oro facial development ⸠Helps in rapid mandibular protrusion when compared to bottle fed babies
- 20. Bottle feeding ⸠Effects on development depends on type of nipples used â ⸠Physiologically designed nipples are developed that promotes the child to work and exercise the lower jaw .
- 21. 2) Non Nutritive habits - Earliest sucking habit adopted by infants ⸠Thumb /digit sucking ⸠Pacifier sucking 21
- 23. 23 Thumb sucking can be defined as repeated forceful sucking of the thumb with associated strong buccal and lip contractions.
- 24. Classification ⸠By Subtleny â cineradiographic 1. Group A (50%). ⸠Whole thumb was inserted in the mouth ,pressing the palate. ⸠Contacts both upper and lower incisors 2. Group B (13-24%). ⸠The thumb placed into the oral cavity without touching the vault of the palate 24
- 25. 3. Group C (20%). ⸠Thumb contacts the palatal vault ⸠Touches only the maxillary incisors 4. Group D (6%). ⸠Very little portion of thumb is placed into mouth. ⸠The lower incisor contacted at a level near the thumb nail. 25
- 26. 26 Psychology of thumb/digit sucking Freudian concept- Sears and wise concept â Prolonged unrestricted sucking habits caused oral drive. Benjaminâs concept â Sucking habits arise from rooting and placing reflexes. Ericksonsâs concept â Development of NNS is due to incomplete resolution of child's stages of development .
- 27. 27 Clinical Features Depends on ďDuration and degree of intensity ďPosition of digits ďType of muscle contraction ďPosition of mandible during sucking ďMorphology of skeletal structures
- 28. 1) Anterior openbite â˘Digits rest on incisors ,prevents complete or continued eruption. â˘Posterior teeth are free to erupt.
- 29. 2 ) facial movement of upper and lingual movement of lower incisors 29 â˘Depends on duration of thumb placement â˘It exerts pressure on labial surface â˘Resultant is increased overjet due to tipping
- 30. 3) Maxillary constriction â˘Greater maxillary arch depth and deceased maxillary width. â˘Equilibrium imbalance between muscles and tongue. â˘Tongue is forced down when tongue is placed. â˘Orbicularis oris and buccinator exerts unrestricted force. â˘No counter force exerted leads to crossbite.
- 31. 4) Alteration of lip tonicity 31 â˘hypotonic upper lip â˘hyper tonic lower lips
- 32. 5) Clean fingers â˘Presence of callus due to irritation â˘Reddened, clean, chapped, short fingernail
- 33. 6) Mandibular rotation â˘Downward and backward rotation due to lowered position while sucking
- 34. 7)Increase in ANB angle â˘Due to maxillary prognathism And mandibular retrognathism
- 35. 8)Can lead to toungue thrusting 35 â˘Due to Appearance of spaces
- 36. Pathophysiology
- 37. Approach to treatment 37 1. Phase 1(Normal/ subclinically significant sucking) ⢠Birth â 3years ⢠Develops and resolves thumb sucking at this age ⢠If signs of malocclusion are seen pacifier or medicaments can be used 2. Phase 2 (clinically significant sucking) ⢠3years- 7years ⢠Firm treatment plan â ( either counseling âappliance therapy) 3. Phase 3 (Intractable sucking) ⢠After 7years ⢠2 fold treatment plan â (both counseling âappliance therapy) By Dr Roni R Kuttickal Coorg Institute of dental sciences
- 38. Types of approach 1. Psychological approach a. Counseling â simplest approach b. Dunlapâs beta hypothesis/negative practice c. Reminder therapy d. Distraction therapy e. Reward system
- 39. Appliance therapy 39 Appliance therapy is a method to physically intervene sucking habits when psychological approach fails Optimal time â 4 - 4.5 years . Purposes 1. Renders habit meaningless ,by breaking suction 2. Finger pressure displacing incisors are reduced 3. Appliance forces the tongue into a normal position reversing constriction
- 40. Appliances used 1. Palatal rake â more a punishment appliance 2. Palatal Crib- ⢠Used in children with no posterior crossbite. 3. Modified palatal crib with quad helix ⢠Can be used in case of posterior crossbite . 4. Bluegrass Appliance ( counter conditioning response) ⢠By haskell and mink ⢠Used in early mixed dentition period ⢠Minimal disturbances while eating and talking 5. Appliance with LED
- 42. Nearly identical to thumb sucking Similar clinical findings, only not that pronounced Rx - throw away the pacifier Caution - child may substitute missing pacifier with a digit! 42
- 43. Tongue Thrusting, Swallowing Habit or Retained infantile swallow 43
- 44. âA condition where in during swallowing the tongue contacts with teeth in anterior regionâ
- 45. Swallowing occurs 24 hours/day ie about 2000 times During each swallow Tongue exerts 1-6 pounds On surrounding structures of the mouth Pushes bone and teeth forward and apart Moves the teeth into abnormal positionsGrowth distortion of face and teeth
- 46. Classification 1. Moyers classification I. Simple tongue thrusting. II. Complex tongue thrusting III. Retained infantile swallow 2. According to the area of Tongue thrusting I. Anterior tongue thrusting II. Lateral tongue thrusting 3. Bahr and Holts classification I. Tongue thrusting without deformation II. Tongue thrusting causing anterior open bite III. Tongue thrusting causing posterior open bite IV. Combined tongue thrusting
- 48. Simple tongue thrust complex tongue thrust Retained Infantile swallow Teeth together swallow Contact of posteriors while swallowing Circumscribed anterior open bite Tongue is places anteriorly for lip seal Tooth apart swallow Generalized open bite Poor inter cuspation Mandible is not stabilized by elevator muscles but facial muscles Poorest prognosis Contact only at molar regions Severe facial muscle activity
- 49. Diagnosis Check for size, shape and movements Observe the tongue during various swallows 1. Conscious swallow 2. Command swallow of water 3. Conscious swallow during mastication
- 50. Palpatory Examination Place water beneath the patients tongue tip and ask him to swallow ⸠Normal: Mandible rises and teeth are brought together but no contraction of lips or facial muscles ⸠Tongue thrusting: Marked contraction of lips and facial muscle 50
- 51. Temporalis/masseter Examination Place hand over Temporalis/masseter Normal: contracts & Mandible- elevated Tongue thrusting: No contraction
- 52. Lip parting Test Normal: no severe muscle contraction Tongue thrusting: severe contraction Cineflurography Test -PAYNE TECHNIQUE Lisping speech Movement of hyoid bone
- 53. Treatment of tongue thrusting 54 1) Corrective therapy a. Removal of obstruction ⢠Surgery for adenoids,macroglossia ⢠Closure of openbite with fixed or removable appliance b. Tongue exercises ⢠Elastic band swallow ⢠Water swallow ⢠Candy swallow ⢠Speech exercises c. Lip exercises ⢠Button pull
- 54. 2.Reminder therapy- a) Subconscious therapy b). Palatal appliances â ⢠Palatal cribs ⢠Spurs ⢠Palatal rolling ball
- 56. â ⸠Mouth breathing is defined as the habitual respiration through the mouth instead of nose 57 By Dr Roni R Kuttickal Coorg Institute of dental sciences
- 57. Classification Mouth breathing Finn (1987) Anatomic Obstructive Habitual
- 58. Causes of reduced nasal flow Frequent respiratory infections Swollen nasel mucosa Enlarged tonsils and adenoids Deviated nasal septum Reduced nasal breathing Constricted maxilla Decreased nasal width Lowered mandibular posture Extended head position Downward and forward tongue positioning Mouth Breathing
- 59. Clinical features Tomes (1872) described characteristics as Adenoid facies â˘Excessive lower anterior face height ⢠Incompetent lip posture ⢠Excessive appearance of maxillary anterior teeth, âGUMMY SMILEâ ⢠A nose that appears to be flattened, nostrils that are small and poorly developed
- 60. ⢠Steep mandibular plane ⢠Posterior crossbite ⢠Open-mouth posture ⢠A short upper lip and a fuller lower lip ⢠A narrow V-shaped upper jaw with a high narrow palatal vault ⢠A class II skeletal relationship ⢠Gingivitis of upper anterior teeth. 61
- 61. â ⸠Diagnosis 1. History 2. Clinical observation 3. Tests to asses mode of respiration 4. Masslers Water holding test-(water in mouth>2mins) 5. Mirror condensation test 6. Jwemensâ Cotton wisp test. 7. Cephalometric analysis 8. Rhinomanometric examination 9. SNORT (Simultaneous nasal and oral respiratory technique) 62
- 62. Treatment 1) ENT Perspective 2) Elimination of nasal obstruction 3) Maxillary Expansion (RME) 4) Breathing exercises ,respiratory effort 5) Oral screens with holes 6) Lip Muscle exercises
- 63. LIP HABITS 64
- 64. HABITS THAT INVOLVE MANIPULATION OF THE LIPS AND PERIORAL MUSCULATURE 65
- 65. Vary with imagination of child Basic type Lip wetting- consists of wetting the lips with the tongue Lip sucking- Entire lower lip + vermilion border pulled in mouth Mentalis habit - Vermilion border is pulled inside mouth + puckering- everted lower lips sub labial contracture line
- 66. Lip habits: Etiology Malocclusion Class II Div-1 Large overjet and overbite Emotional stress Increases the intensity and duration
- 67. Reddened , irritated, chapped area below vermilion border Relocation of vermilion border Redundant and hypertrophied lips puckering up of chin during swallow Herpetic infection 68
- 68. â˘Protrusion of upper incisors Flaring with interdental spacing Retrusion of lower incisors Collapse with crowding openbite 69
- 69. Lip habits: Treatment 1) Establishment of normal occlusion 2) Counseling 3) Appliance therapy ⢠Upper and lower lip bumpers ⢠Oral shield
- 70. Bruxism 71
- 71. ⸠Bruxism is commonly defined as âgnashing and grinding of the teeth for the non-functional purposesâ
- 72. ETILOGY OF BRUXISM 1. Emotional basis: anxieties. 2. Local theory: some irritating dental condition. 3. Systemic disorders- 4. Psychological - stress 5. Discrepancy between centric relation and centric occlusion â
- 73. SIGNS AND SYMPTOMS â˘Not like normal wear patterns. â˘more severe on natural anterior teeth â˘On denture, The wear may be more severe on the posterior teeth â˘Unexpected fractures of teeth or restorations â˘Unexpected mobility of teeth or restorations.
- 74. 75 ⢠Soreness of masticatory muscles. ⢠Tender spots ⢠locking of the jaw. ⢠Accidental cheek, lips and tongue bite ⢠Headaches ⢠TMJ discomfort and pain. ⢠Audible occlusal sounds of non-functional grinding
- 76. METHODS OF TREATMENT Psychotherapy: Autosuggestion and hypnosis: Relaxing exercise and physiotherapy: Elimination of oral pain & discomfort:
- 77. OCCLUSAL THERAPY â˘Occlusal adjustment â â˘Elimination of Occlusal interferences - â˘Anterior bite plane. â˘Posterior bite plane. â˘If unsuccessful, referral to appropriate medical personnel to rule out systemic factors. â˘If neither of these two steps is successful, a mouth guard. stainless steel crowns
- 78. 79 PURPOSE OF BITE PLATE AND SPLINTS â˘Elimination of occlusal interference. â˘Avoid occlusal wear. â˘To restrain the jaw movements and break the habit of Bruxism.
- 80. â ⸠It is an activity similar to thumb sucking ⸠disappear by about 2nd year of life. ⸠Persistence - organic cause ⸠Substitute ⸠Rx 81
- 82. Rarely seen Seen in midline diastema cases Child locks his frenum in this gap Starts as idle play Displacing habit Rx
- 84. Postural defects during sleep . Children and adults do not lie in one position. Deformity, flattening of the skull and facial asymmetry. Seen in infants who habitually lie in supine position.
- 85. Nail biting 86
- 86. Develops- 3years of age. Constant 4-6 years. Peaks in adolescence Nail biting - Thumb sucking stage. 80% of all individuals have been or are nail biters. Correlation with stuttering
- 87. 88 Clinical Features Does not assist in the production of malocclusion Forces in nail biting -similar to those in the chewing process Attrition of the lower anterior teeth, Crowding and rotation have been observed.
- 90. Postural habits related malocclusion are rare Treated orthodontically on an individual basis. Includes - 1 -chin propping â mandibular retrusion 2- face leaning âlingual tipping of teeth 3 -Milwaukee brace for scoliosis âmandibular retrusion 91
- 92. â ⸠93 Repetitive acts that result in physical damage to the individual
- 93. Incidence extremely rare in the normal child 10-20% mentally retarded Attention seeking disorder
- 94. Self-mutilation habits include Lip biting Tongue biting Cheek biting Gingival striping Finger biting
- 95. Treatment Multidisciplinary approach Palliative treatment squib oral bandage Oral shield By Dr Roni R Kuttickal Coorg Institute of dental sciences
- 96. 97 Conclusion Every age has its own set of habits Itâs the role of the dentist to identify such habits and correct the habit at the root level We as orthodontist play a major role in intercepting this habits . A bit more careful observance and effort from our part , can go a long way in helping a child or adult in having a stable occlusion ,a beautiful smile and a healthy life By Dr Roni R Kuttickal Coorg Institute of dental sciences
- 97. References ⸠Jyoti and pavanalakshmi, dentistry 2014, 4:3 doi: 10.4172/2161- 1122.1000203 ⸠Oral habits a behavioral approach âjohn et al ⸠Oral habits: considerations in management â paul et al ⸠Pressure habits etiological factors in malocclusion - klein ⸠Sridhar Premkumar ⸠Op kharbandha ⸠Graber ⸠Avery 98
- 98. Thank you 99
Editor's Notes
- What is a habit ..? Itâs a n action that gets fixed to an induvidual by repetition A similar situation seen in our department is going to ashraf ikkas .
- DEVELOPMENT OF A HABIT 25. Development of a habit ď¨ The newborn develops some instincts, which are composed of elementary reflexes. ď¨ Instinct : pattern and order are inherited, ď¨ Habit: pattern and order are acquired, if constantly repeated during the lifetime of an individual.
- How does it develops
- Teeth and supporting structures Many reaserchers like worms and tulley These habits bring about harmful unbalanced pressures on the immature, highly malleable dental arches, the potential changes in the position of the teeth, and occlusion Which may become abnormal if these habits are continued for a long time.
- During the first 3 yrs Damage can be DETRIMENTAL The worst amount of damage seen damage confined Anterior Segment Anterior Open Bite ďź Beyond the age of 3.5 yrs if the habit is continued ďź After 4 years of age the habit becomes ďź After the eruption of the permanent incisors
- alocclusion and Habits ďź Position of the digit/pacifier etc. ďź Associated orofacial muscle contraction force ďź Mandibular position during sucking ďź Facial skeletal genetic pattern ďź Amount, frequency, & duration of force applied The type of malocclusion produced by the habit is dependent on the following variables:
- Several authors hav classified habits Kleins classification Empty habits â without any psycological background Meaning full habits â associated with any psychological problems Morris and bohana Pressure habits- eg tongue thrusting,digit sucking, Non pressure â no force application on teeth Eg mouth breathing Biting habits â nailbiting ,pencil biting William james classification. Useful , harmful Kingsley functinal , muscualar combined
- Ernest klein et al, 1952 ajo â published pressure habits ,etiologic factors in mal occlusion orthodontic appliances Myofunctional therapy Other habits like Intentional head deforation Padong giraffe Lotus foot
- JAMES W. (1923) Include the habits of normal function such as: a)correct tongue position, b)proper respiration, c)proper deglutition and d)normal usage of lips in speaking. USEFUL HARMFUL
- The effects of bottle feeding on the dentofacial development vary according to the type of the nipples used. Some Nipples are physiologically designed and referred to as âorthodonticsâ. With the physiologically designed nipple there is forward movement of the tongue under the flat surface of the nipple that draws it backward and upward against the hard palate of the infant. Consequently the child has to work and exercise the lower jaw. The posterior part of the tongue then awaits the milk and pushes it down into the esophageal area. Thus milk flows due to the peristaltic like action of the tongue and cheeks, instead of being squirted in to the throat that occurs when an inadequate nipple is used. The physiologically designed nipples seems better adapted to the anatomy and physiology of sucking
- Non nutritive form: Nonnutritive sucking is the earliest sucking habit adopted by infants in response to frustrations and to satisfy their urge and need for contact Ensures a feeling of well feeling, warmth and sense of security
- Thumb sucking may be practiced even in intra-uterine life 28 weeks of life and is considered as normal till age of 3 1/2 to 4 years.
- GRADING OF THUMB SUCKING BY SUBTELNY (1973) maxillary and mandibular anteriors contact is present. TYPE TYPE C â (18% ) ď§ thumb is placed into the mouth just beyond the first joint and contacts the hard palate and only the maxillary incisors ď§ no contact with mandibular incisors. TYPE D â (6%) ď§ very little portion of thumb is placed into mouth.
- no contact with mandibular incisors. TYPE D â (6%) ď§ very little portion of thumb is placed into mouth.
- Similar to one Gained during nursing and nourishment , and lack of this suckinling habits caused this habits 2) Ths contradicted freuidian concept= Sucking was considered as a means of stimulating the pleasure associated with feeding. 3) Rooting refex is movement of infants head towards an object touching the cheek, usually mothers breast ,this could be a digit or thumb,this is one form of communication of the child 4 ) according to him a man goes through 8 stages of life , the first stage is development of basic trust , if the child patient bond is not developed properly , child deals with anxiety by a habit resembling nutritive sucking subconciously, thus it becomes a fixation or habit. Finger sucking habit is a repeated stereotyped behaviour pattern with multifactorial nature and adaptive value
- Crowbar effect
- Reddened, clean, chapped, short fingernail (dishpan thumb) Chronic suckers - fibrous, roughened callus on superior aspect of finger Deformation of finger
- Complementery buy one get one free
- Child should be give a chance to stop the habit on his own before permanent, tooth erupt, this can happen due to peer pressure , treatment should be undertaken from 4-6 years
- 1- councelling discussion with the patient,talk with him about the problems, best suited for olderchildren ,nagging can worsen. Photos of maloccluion , cards for scoring his own habits , audio visual aids 2 child is made to sit in front of the mirror and asked to suck his finger , this conscious repetition makes child discomfortable Hampers his own pleasure 3- reminder therapy is usefl for children who are ready to quit habit (adhesive bandage , neem , bitter substance ACE bandage â decreased blood flow) magic pill Cover the palm with socks Three-alarm system 4) Long hugs , comfortable objects , passifier 5) Stop habits by giving rewards , stars for every day without habits Reward and reminder system can be given together
- effective means of intercepting Blue grass â consist of 6 sided roller â machined from teflon 0.045 inch wire Maxillary molars or decidious Fixed or removable Minimum 6 months of use
- Includes the physiologic pacifiers like the NUK. ďź Nearly identical to thumb sucking ďź Similar clinical findings, only not that pronounced! ďź Tx - throw away the pacifier! ďź Caution - child may substitute missing pacifier with a digit! Pacifier/Binkie Habit
- One pound is 453 grams So almost half to 3 kg
- Strubs classification group 1 â midline diastema Group 2 anterior open bite Group 3 side thrust Group 4 cross bite â poorest prognosis Complex â tooth apart swallow Generalised open bite Poor intercuspation Mandible is not stabilised by elevator muscles
- Maturational factors . A transitional period from infantile swallow to mature swallow also exhibits tongue thrusting. Tongue thrusting may develop as a sequela of prolonged thumb sucking and retained infantile swallow Anatomic factors In macroglossia, there is overgrowth of the tongue.Pressure is exerted against the lingual surfaces of the teeth, causing them to become spaced. Indentations on the tongue often appear where the tongue pushes against the teeth. ⢠Adenoids and tonsils cause the tongue to be positioned anteriorly to prevent blocking of the oropharynx. Tongue thrusting is also called an adaptive behaviour. If large spaces are present anteriorly in the upper and lower teeth, then the tongue will try to move into these spaces to achieve the anterior seal. Neurogenic factors. Hypersensitive palate causes the tongue to be pushed forward.
- Simple : Normal tooth contact during the swallowing act. ⢠Anterior open bite. ⢠Good intercuspation of teeth. ⢠The tongue thrust forward to establish anterior lip seal. ⢠Abnormal mentalis muscle activity Complex :Teeth apart during swallow. ⢠Diffuse or absent anterior open bite (Bimaxillary protrusion) ⢠Absence of temporal muscle constriction during swallowing. ⢠Contraction of the circum oral muscles during swallowing. ⢠Poor occlusion of teeth
- Exaggerated perioral contraction during swallowing Increased vertical dimension of face Intraoral Examination appearance of open bite spacing between teeth gushing of saliva through the spaced dentition . Tongue thrusting: No temporalis contraction 3. Hold the lower lip withThumb
- hand over temporalis muscle and ask to swallow a. Normal: Temporalis contracts & Mandible- elevated bExtra oral examination
- sodium fluorescein solution in a water soluble base is used. S N T D
- Interception is age related , Child below 3 years of age no active treatment is required Tongue exercises â Elastic band swallow The elastic band is kept on the tip of the tongue and the palate and swallowing is practised â Water swallow To keep water in mouth and a mirror in hand, and swallowing is practised daily â Candy swallow A candy is placed between the tongue and palate and swallowing is practised â Speech exercises Patient practises syllables like c, g, h, k while keeping an elastic band between the tongue and the palate Lip exercises Patient practises stretching of lips so as to achieve anterior lip seal Multiples of 6 Spot salivate squeese swallow
- mouth breathers are those who breathe orally even in relaxed and restful conditions
- Anatomic- under developed nasal complex Obstructive â with rhinitis , allergies Habitual Mouth breathers â force of habit
- This again with strech theory of solow and krei berg ⌠1977 There is a soft tissue strech â differential force on the skeleton , morphologic change ,- obstruction of airway- neuromuscular feedback cause â change in posture
- Differential pressure â chronic nasal obstruction , This was aka respiratory obstruction syndrome long face syndrome or vertical maxillary excess
- More than this there are also many medical complications associated Like reduction in their airway Sleep disturbances Constant fatigue Dimution in growth due to improper hormone flow Poor academics ,bags under their eyes
- Lip contacts ,lip apart Good alar reflex No change of alar , no external nare changes 3. Cotton wisp test. A small wisp of cotton (butterfly shaped) is placed below the nostrils in a butterfly shape. If the upper fibres are displaced then the breathing is through the nose. If the lower fibres are displaced then it is mouth breathing habit. Cephalometric analysis ⢠Lateral view may show presence of enlarged adenoids and tonsils ⢠Cephalometric analysis for nasopharyngeal airway show altered parameters ⢠VME cases also exhibit typical cephalometric features that make a ready diagnosis. Rhinomanometric examination ⢠Nasal resistance and airflow are measured with the help of a rhinomanometer. ⢠A high value of nasal resistance signifies nasal obstruction and mouth breathing ⢠SNORT (Simultaneous nasal and oral respiratory technique). This is a highly accurate technique for quantifying respiratory mode, wherein both nasal and oral respiration are simultaneously recorded and calibrated. The readings of both oral and nasal respiration are recorded in waveforms which can be later converted into a digital format.
- Deep breathing exercises are done with inhalation through the nose with arms raised sideways. ⪠After a short period, the arms are dropped to the sides and air is exhaled through the mouth.
- Normal lip anatomy and function are important for speaking, eating and maintaining a balanced occlusion.
- The first motion of the act consists of wetting the lips with the tongue, the lower lip is turned inward and tongue goes back into the mouth. As the tip of the tongue passes the incisal edges of the maxillary incisors, the lower lip is caught between maxillary and mandibular teeth and pressure is exerted as the lip slowly returns to its original position. The force produced by the lip as it slides around the teeth moves maxillary incisor labially and mandibular incisors lingually. The deformity reaches maximum when discrepancy between the maxillary and mandibular incisors become equal to the thickness of the lower lip.
- . a sub labial contracture line develops between lip and chin.
- inclination of incisors leading to increased overjet
- As there is no use in intercepting the habit without correction of etiology mere lip appliance would do nothing If its associated with any psychological factors or nervousness
- French â La Bruxomanieâ suggested by Marie and Piet Kiewicz in 1907 dental literature under many other terms as Stridor dentium Occlusal necrosis Neuralgia traumatic (Karolyi) Karolyi effect (Weski) Occlusal habit neurosis (Tisher) Para function (Drum) Diurnal or nocturnal
- Emotional basis:. Generally occurs in children with other habit pattern such as thumb sucking and nail bitting. Local theory: Suggests that bruxism is a reaction to an occlusal interference, high restoration or some irritating dental condition. Systemic: Factors implicated in bruxims include intestinal parasites, sub-clinical nutritional deficiencies, allergies and endocrine disorders, chorea, epilepsy and meningitis etc. Psychological theory: Submits that bruxism is the manifestation of a personality disorder or increased stress. Children with musculo-skeletal disorders (cerebral palsy) and severely mentally retarded children commonly grind their teeth. In these patients bruxism is the result of their underlying physical and mental condition and is difficult to manage dentally. Discrepancy between centric relation and centric occlusion â most common trigger factor for bruxism. Working side/ balancing side interferences also trigger bruxism.
- Such wear facets are seen at the incisal tip of maxillary cuspids. They are often rounded over the labial surface of the cusp tip instead of blending into the lingual attrition facets that occur from mastication. They are also seen on incisors, bicuspids as well as on other teeth. Wear pattern of long standing bruxism is often very uneven and usually more severe on anterior than on posterior teeth in natural dentition. In patients who have denture, the wear may be more severe on the posterior teeth than the anterior teeth since the stability of the denture allows for the greatest pressure in the posterior regions. Unexpected fractures of teeth or restorations Unexpected mobility of teeth or restorations. Increased tonus and hypertrophy of masticatory muscles
- Soreness of masticatory muscles. Â i. Tenderness on palpation. Tender spots â more common along the anterior and lower border of the masseter and medial pterygoid and also in temporal regions. iii. Complain of tired feeling in the jaws when they wake up in the morning or They experience a locking of the jaw and the masseter and temporal muscles have to be massaged before the jaws can be opened. iv. . v. Sometimes headaches of the type usually called tension or emotional are associated. vi. TMJ discomfort and pain. viii. Audible occlusal sounds of non-functional grinding.
- Electromyography shows abnormally high muscle tones in the jaw muscles; especially an inability to relax between occlusal contacts is highly indicative of bruxism. Occlusal analysis: detect any prematurities. Use of temporary bite planes or occlusal splints to achieve muscle relaxation to diagnosis the occlusal trigger factors of bruxism.
- Psychotherapy: Psychoanalysis and appropriate treatment by a clinical psychologist. Autosuggestion and hypnosis: have been suggested by several authors. Both of them have limited value in its clinical application. Relaxing exercise and physiotherapy: Relaxing exercises both of general and local nature may serve to decrease the muscle tension and bruxism. Exercises, massage, heat and other form of physiotherapy will provide some relief for bruxism as for myalgia of postural or other nature, but since it does not cure the bruxism it should be used only to support the other forms of therapy. Elimination of oral pain & discomfort: It will lower the muscle tonus and reduce the trigger zones, which might be responsible for bruxism
- Occlusal adjustment -eliminate the prematurities â Elimination of occlusal interferences by restorative therapy using inlays, onlays and replacement of missing teeth if it is required. Anterior bite plane. Posterior bite plane. If occlusal interferences are not located or equilibration is not successful, referral to appropriate medical personnel to rule out systemic factors. If neither of these two steps is successful, a mouthguard like appliance can be constructed of soft plastic to protect the teeth and attempt to eliminate the grinding habit. Rarely will occlusal wear be so great that stainless steel crowns are necessary to prevent pulpal exposure or eliminate tooth sensitivity.
- If it is persisting in late childhood there may be an organic cause such as oral irritation or allergy. Tongue sucking may be substitute habit when thumb sucking is prohibited to the child.
- If the upper permanent incisors are spaced slightly apart, the child may lock his labial frenum between these teeth and permit it to remain in this position for several hours. This habit probably starts as idle play but may develop into a tooth âdisplacing habit by keeping the central incisors apart, the effect being similar to that produced in instances by an abnormal frenum. This habit is rarely seen.
- Postural defects during sleep have been considered as an etiologic factor in malocclusion. nervous reflexes in order to obviate pressure interference with circulation. Deformity, flattening of the skull and facial asymmetry may occasionally develop during the first year in infants who habitually lie in supine position with the head turned toward right or left.
- among well-adjusted and as well as poorly adjusted children.. Every age has its own pacifiers like chewing gum , pencil , toungue cheek cigarettes etc
- Nunn and Azrin They can be taught activities which are in compliable with nail biting such as manicuring them and then grasping an object firmly or clenching the first when tempted to bite the nails.
- Self-mutilation
- self-mutilation is a learned behaviour. attention is always gained. Such children should be referred for psychological evaluation and treatment. Self-mutilation has also been associated with biochemical disorders, such as Lesch-Nyhan and De Largeâs syndromes. Besides behaviour modification, treatment for self-mutilation includes use of restraints, protective padding and sedation. If restraints and protective padding are unsuccessful, extraction of selected teeth may be necessary.
- Ginerails
- Thumb sucking evolves to nail biting which evolves to other oral habits like smocking as age progresses